- N Engl J Med 2022; 387:167-167
A 30-year-old man presented with a morbilliform rash and fever after taking an antimicrobial agent. Facial edema, eosinophilia, and elevated liver-enzyme levels developed later.
- N Engl J Med 2021; 385:2281-2281
A 6-year-old girl with perennial sneezing and nasal congestion presented with transverse nasal creases. During the examination, she rubbed her nose in an upward manner, a motion known as the “allergic salute.” Allergic rhinitis was diagnosed.
- N Engl J Med 2021; 385:1033-1033
A 7-year-old girl presented with an itchy rash after 1 week of treatment with amoxicillin for pharyngitis. She had erythematous papules and macules on her face, trunk, arms, and legs. The result of a mononuclear spot test was positive, and a diagnosis of amoxicillin rash in infectious mononucleosis was made.
Delayed Large Local Reactions to mRNA Covid-19 Vaccines in Blacks, Indigenous Persons, and People of ColorN Engl J Med 2021; 385:662-664
Previous reports document a small risk of delayed large local reactions to Covid-19 vaccines; however, clinical photos most often show White persons. Reactions have also been noted in vaccine recipients who are Black, Indigenous, or People of Color (BIPOC). Photos of eight such delayed reactions are shown.
- N Engl J Med 2021; 384:2156-2158
Recent findings based on a mouse model suggest that a peripheral immune mechanism may underlie the symptoms associated with abdominal pain in patients with irritable bowel syndrome.
- N Engl J Med 2021; 384:1283-1286
Although “red man” might, at first glance, be taken as a straightforward description of a white male patient with an erythematous skin reaction, the term had a ready referent outside medicine, where it had long carried racist connotations.
- N Engl J Med 2021; 384:643-649
The vast majority of people who have received the Covid-19 vaccine to date have had self-limited local or low-grade systemic reactions that resolve within 2 or 3 days. A very small number of people have had serious anaphylactic reactions requiring catecholamine infusion and respiratory support. It is important to survey...
- N Engl J Med 2021; 384:462-467
A 47-year-old man in Michigan presented to the ED with a 1-day history of presyncope, swelling of the eyelids, and diffuse pruritic rash. He reported a 3-week history of postprandial watery bowel movements and a 5-day history of diffuse, crampy abdominal pain.
- N Engl J Med 2020; 383:2462-2470
A 29-month-old boy with a history of febrile seizure, atopic dermatitis, and multiple environmental and food allergies was transferred to the hospital because of a seizure and a blood calcium level of 5.0 mg per deciliter (reference range, 8.5 to 10.5). He had a pes planus deformity. A diagnostic test...
- N Engl J Med 2020; 383:1389-1391
Benralizumab, an anti–interleukin-5-receptor antibody, was evaluated in a 24-week study involving 12 patients with chronic spontaneous urticaria. The disease was assessed on the basis of urticaria activity scores. After three monthly injections and 2 months without benralizumab, 5 patients had a complete response and 2 had a partial response.
- N Engl J Med 2020; 382:574-575
Asthma is a major cause of illness and health care costs: in 2016, almost 200,000 Americans were admitted to the hospital for an asthma attack, and 40% of them were children (https://www.cdc.gov/asthma/healthcare-use/healthcare-use-2016.htm ). It therefore makes sense to consider asthma prevention a major public health priority. In most cases...
- N Engl J Med 2020; 382:525-533
In a previously published controlled trial, maternal administration of vitamin D during pregnancy was found to protect against wheeze in the offspring at the age of 3 years. In this follow-up study involving the same children at the age of 6 years, that supplementation no longer had a protective effect.
- N Engl J Med 2019; 381:2338-2351
Many more patients are labeled as penicillin-allergic than actually are allergic. The label should be analyzed with skin testing and test exposure. Patients with true penicillin allergy can be desensitized with a slow-escalation protocol under physician observation.
- N Engl J Med 2018; 379:2176-2177
Some patients have immediate hypersensitivity responses to olaparib therapy. A gradual increase in oral doses over a 2-day period was successful at desensitization.
- N Engl J Med 2018; 379:2074-2075
Once a peanut allergy develops, advice has historically been simple: lifelong complete avoidance is needed to prevent systemic allergic reactions, some of which could be fatal. However, over the past decade, a series of case reports and small studies have shown that the systematic introduction of tiny amounts of peanut...
- N Engl J Med 2018; 379:1991-2001
A peanut-derived protein product, AR101, used in an oral desensitization protocol in children and adolescents with severe peanut allergy increased the amount of oral peanut protein tolerated in approximately two thirds of participants who received AR101, as compared with 1 of 25 controls.
- N Engl J Med 2018; 379:352-362
The clinical consequences of defects in C1 inhibitor function can be serious. A series of advances have improved the outlook for patients with hereditary angioedema. The latest development is an effective oral kallikrein inhibitor that reduces the attack rate by nearly 75%.
- N Engl J Med 2017; 377:1569-1578
A 64-year-old man presented with headache, dyspnea, wheezing, cough, and night sweats. He had eosinophilia, sinusitis on CT, and abnormal results on pulmonary-function tests, including an elevated fraction of exhaled nitric oxide. Diagnostic tests were performed.
- N Engl J Med 2017; 377:1168-1176
Management of food allergy includes recognition of anaphylaxis, availability of epinephrine, avoidance of food allergens, and education about safe foods. Early introduction of peanuts in the first year of life significantly reduces the risk of peanut allergy.